Diabetes Mellitus In Obese Patients Research Articles

Alanine transferase levels (ALT) and triglyceride-glucose index are risk factors for type 2 diabetes mellitus in obese patients

AimsThe role of liver steatosis and increased liver enzymes (ALT) in increasing incident type 2 diabetes mellitus (T2DM) is debated, because of their differential effects on different ethnicities and populations. The aim of this study was to evaluate the role of elevated ALT in the development of T2DM in non-diabetic obese subjects receiving routine medical treatment.MethodsA total of 1005 subjects [296 men and 709 women, aged 45.7 ± 13.12 years, body mass index (BMI) 39.5 ± 4.86 kg/m2] were followed for a mean period of 14.3 ± 4.44 years. Subjects were evaluated for several metabolic variables, including the triglyceride-glucose index and the presence of metabolic syndrome (IDF 2005 definition), and were subdivided into ALT quartiles.ResultsT2DM developed in 136 subjects, and the difference was significant between the first and the fourth ALT quartile (p = 0.048). Both at univariate analysis and at stepwise regression, ALT quartiles were associated with incident T2DM. Traditional risk factors for T2DM coexisted, with a somehow greater predictive value, such as triglyceride-glucose index, age, arterial hypertension, LDL-cholesterol, and metabolic syndrome.ConclusionsThese data suggest an association between elevated ALT levels and the risk of incident T2DM in obesity.

Effect Ayurveda-based Comprehensive Diabetic Care Program on Glycemic Control in Type 2 Diabetic Mellitus Patients: An Observational Study

Background: The prevalence of diabetes mellitus in India is alarmingly high despite availability of several therapeutic agents. Thus, the current study was conducted to understand the role of Ayurveda based Comprehensive Diabetes Care (CDC) program in the management of type 2 diabetes mellitus.
 Methods: A retrospective, observational study was conducted from January 2014 to September 2022 at Madhavbaug Clinic, Maharashtra. Patients aged 18 years and above with a diagnosis of type 2 diabetes mellitus according to the American Diabetes Association (ADA) with body mass index >25 participated in the CDC program and were included in this study. Follow-up was conducted after 90 days. Baseline data was compared with follow-up data.
 Results: A total of 63 patients were assessed. Of the male patients, 29.3%, 43.9%, and 26.8% were found to have impaired, negative and positive glucose tolerance. Among the females, 22.7%, 63.6%, and 13.6% were found to be have impaired, negative and positive glucose tolerance. Weight decreased from 70.70 ± 9.82 kg to 65.15 ± 9.83 kg (p<0.001) from day 1 to day 90. Body mass index decreased from 27.00 ± 3.88 to 24.91 ± 3.75 (p<0.001) from day 1 to day 90. Glycated haemoglobin (HbA1c) decreased from 7.87 ± 1.90% to 5.79 ± 0.51% (p<0.001) from day 1 to day 90.
 Conclusion: Remission of type 2 diabetes mellitus in obese patients is possible with Ayurvedic principles and diet compliance.

Comparison of therapeutic effect of metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus in obese patients

To evaluate the therapeutic effects of two therapeutic strategies based on metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus (T2DM) in obese patients. We retrospectively collected the clinical data of 107 obese patients (BMI>25 kg/m2) with T2DM treated in Second Affiliated Hospital of Wannan Medical College (Wuhu, China) during 2019-2021, including 53 patients treated continuously with metformin hydrochloride/vildagliptin and 54 with liraglutide for 3 months. The changes in BMI, waist circumference, fasting blood glucose (FBG), postprandial blood glucose, HbA1C, fasting C-peptide, postprandial C-peptide, fasting insulin and postprandial insulin of the patients after treatment were compared between the two groups. In both of the groups, the patients all showed significant reductions of BMI, waist circumference, FBG, postprandial blood glucose and HbA1C (all P < 0.05) with improved fasting and postprandial C-peptide levels after the treatments (P < 0.05). The two treatment regimens showed comparable blood glucoselowering effects, but liraglutide produced better effect in reducing waist circumference (P < 0.01). Neither of two regimens obviously affected insulin level of the patients (P>0.05). Both metformin hydrochloride/vildagliptin and liraglutide have good therapeutic effects on T2DM in obese patients and can achieve good blood glucose and weight control, but liraglutide has a better effect for weight control.

The role of glucagon-like peptide 1 in the remission of type 2 diabetes mellitus in obese patients after metabolic surgery

The role of glucagon-like peptide 1 in the remission of type 2 diabetes mellitus in obese patients after metabolic surgery

Leptin Resistance as a Risk Marker of Type 2 Diabetes Mellitus in Obese Patients

The purpose of the study was to investigate the influence of leptin resistance on the formation of the risk of type 2 diabetes mellitus in obese patients. Materials and methods. We monitored 50 obese patients who consulted an endocrinologist and a gastroenterologist-nutritionist during 2021-2022. The diagnosis of obesity was made on the basis of bioimpedance examination, as well as by calculating the body mass index. Results and discussion. The article describes and analyzes the level of leptin and leptin resistance as a marker of the risk of type 2 diabetes mellitus in obese patients. To establish the diagnosis of obesity, all patients underwent a bioimpedance examination, and the body mass index was also calculated. Obesity was diagnosed when the body fat content of women was more than 40%, men – more than 28%, and body mass index – more than 30 kg/m2. To identify the syndrome of insulin resistance, the index of insulin resistance was calculated according to the formula: HOMA-IR = fasting insulin (μIU/ml) x fasting glucose (mmol/l) / 22.5. Values exceeding 2.0 were considered insulin resistance. Leptin resistance was diagnosed by determining the presence of the leptin receptor gene and leptin level in blood serum. Leptin resistance was considered to be values of leptin indicators for men more than 5.6 ng/ml, for women – more than 11.1 ng/ml. The level of leptin in blood serum in the group of healthy individuals was within the range of 6.36 ± 2.09 ng/ml in women and 2.96 ± 1.84 ng/ml in men. On the other hand, in obese patients, the serum leptin concentration was 51.49 ± 8.33 ng/ml and 29.71 ± 6.93 ng/ml, respectively. Also, according to the results of the study, a significantly higher level of insulin resistance was observed in all obese patients compared to the control group. These values were at the level of 6.64 ± 2.81 and 7.11 ± 3.52, respectively. Analyzing the results of the study, a reliable relationship between the level of leptin and the severity of obesity was found in all patients. A clear relationship between leptin level and the degree of insulin resistance was also determined. A correlation between the level of leptin and HOMA-IR (r=0.70333; p=0.052) was established, as well as a correlation between fat content, body mass index, leptin level and HOMA-IR (r=0.86187, р=0.0086; r=0.93595, р=0.009; r=0.78098, р=0.007). The detected changes indicate a possible role of leptin and leptin resistance in the pathogenesis of type 2 diabetes mellitus and indicate that the level of leptin can be used as a predictor of the risk of developing type 2 diabetes mellitus in obese patients. Conclusion. An increase in leptin level in blood serum is observed in obese patients. The level of leptin affects the degree of insulin resistance and can be an additional marker of the risk of type 2 diabetes mellitus in obese patients

Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study

Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study

Патогенетичні зміни експресії апоптотичного маркеру каспази-3 у хворих на цукровий діабет II типу з надлишковою масою тіла та ожирінням

The determination of molecular mechanisms, genetic control pathways, and modeling of apoptotic processes are necessary for understanding the pathogenesis of type 2 diabetes mellitus, especially in combination with obesity and excess body weight, which in the future may create prerequisites for the search for pathogenetic treatment. The purpose of the study was to assess the state of apoptosis processes in patients with type 2 diabetes mellitus in combination with excess body weight and obesity, depending on the clinical characteristics of the disease. Material and methods. 98 people with diabetes mellitus were examined. The first group consisted of 64 people with excess body weight and obesity (body mass index &gt;25). The second group included 34 people with type 2 diabetes mellitus and normal body weight (body mass index ≤25). The control group consisted of 28 practically healthy individuals, who were comparable to the first and second groups by gender and age. Results and discussion. The presence of type 2 diabetes mellitus, excess body weight and obesity in patients led to increasing the level of the marker of apoptotic death of body cells – caspase-3 by 16.52%. Patients with glycated hemoglobin HbA1c more than 8% showed an increase in caspase-3 compared with patients with compensated diabetes mellitus; the difference was more pronounced in patients with excess body weight and obesity (19.13%, p &lt;0.05). An increase in the duration of type 2 diabetes mellitus led to the activation of apoptosis processes, which was manifested in the rise of the studied apoptosis marker, caspase-3, both in patients with and without obesity (p &lt;0.05). The development of the complication of type 2 diabetes mellitus in obese patients increased caspase-3 levels by 29.04% (p &lt;0.05) in the absence of significant changes in this marker in patients with type 2 diabetes mellitus without obesity. Conclusion. The dynamics of apoptotic processes in patients with type 2 diabetes mellitus combined with and obesity, depending on the clinical characteristics of patients, is closely related to the level of apoptosis marker – caspase of the cysteine proteinase group – caspase-3

The rs10401670 variant of the resistin gene is related to circulating resistin levels, insulin resistance, and presence of type-2 diabetes mellitus in obese patients

Background: the SNP 3´UTR C/T (rs10401670) of the RETN gene is a polymorphism that has been associated with the presence of type-2 diabetes mellitus in a single work in the literature. Objective: the objective of our study was to evaluate the influence of this resistin gene SNP (rs10401670) on the serum levels of resistin, as well as on the presence of type-2 diabetes mellitus in obese subjects and on insulin resistance. Material and methods: a Caucasian population of 653 obese subjects was analyzed. All subjects underwent an anthropometric evaluation (weight, waist circumference, fat mass), an evaluation of their nutritional intake, a biochemical profile (glucose, insulin, C-reactive protein, lipid profile, insulin, HOMA-IR), and an assessment of the rs10401670 genotype. Determinations were made in the presence of type-2 diabetes mellitus (DM2). A univariate analysis was carried out and a logistic regression was performed with a dichotomy parameter (DM2: yes/no) (SPSS, 17.0, IL, EUA). Results: genotype distribution was as follows: CC, 212 subjects (32.4%); CT, 340 subjects (52.0%); and TT, 101 subjects (15.6%). There were no significant differences between both genotypes in lipid profile, basal glucose, C-reactive protein, anthropometric parameters, nutritional intake, and blood pressure levels. Serum resistin levels (delta: 1.0 ± 0.2 ng/mL; p = 0.02), insulin levels (delta: 1.3 ± 0.1 ng/mL; p = 0.02), and HOMA-IR (delta: 1.2 ± 0.2 ng/mL; p = 0.01) were higher in T-allele carriers than non-T-allele carriers. The overall prevalence of type-2 diabetes mellitus (DM2) in the sample was 21.8%. With respect to the rs10401670 polymorphism, 17.9% of subjects with the CC genotype had DM2, and 23.8% of T-allele carriers had DM2. In the logistic regression analysis the T-allele of the SNP rs10401670, adjusted by age, sex, resistin levels, and body weight showed an association with DM2 - OR: 2.27 (95% CI: 1.26-4.09). Conclusions: the T-allele of the rs10401670 genetic variant is associated with higher levels of resistin, basal insulin, and insulin resistance, and a higher prevalence of type-2 diabetes mellitus, in obese subjects.

Comparative Study between Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini Gastric Bypass in Control of Type 2 Diabetes Mellitus in Obese Patients

Background: Among morbidly obese adult patients (body mass index (BMI) <40 kg/m2) those who are super obese (BMI < 60 kg/m2) present particular challenges for bariatric surgeons. Management of super obese (SO) patient has been associated with higher morbidity and mortality and increase surgical risk. The optimal surgical management of these patients is controversial. Aim: This work aimed to focus light on super obese patient. Considering the advantages, the disadvantages and determine long-term outcome of different plans of management regarding the recent guidelines for this group of patients. Patients and Methods: This study included 60 obese patients with type 2 diabetes mellitus (DM) and randomly divided using closed envelopment method into two groups: Group (1): (30 patients) treated by laparoscopic Sleeve gastrectomy (LSG), Group (2): (30 patients) treated by laparoscopic Mini-Gastric Bypass (MGB). Results: This study included 60 obese patients with type 2 D.M. As regard all sample patients (60 obese patients with type 2 D.M), the group age ranged between 22 -55 years with a mean ± SD of 37.88 ± 9.52 years. The group BMI ranged between 37 – 72 kg/m2 with a mean ± SD of 52.42 ± 9.45 kg/m2. Of the 60 patients, 38 patients (63.3%) were women and 22 patients (36.7%) were men. Conclusion: Bariatric surgery (LSG and MGB) is not only weight reducing surgery but a metabolic surgery which can cure most of the metabolic syndrome and they are considered the most effective long term treatment modality for type 2 diabetes in obese patients and with comparing between LSG and MGB, our study suggests that MGB has better and earlier effect than LSG in diabetes remission.

Duodeno-Jejunal Bypass Liner for the Treatment of Diabetes Mellitus in Obese Patients—Completeness of Duodenal Blinding as the Key Factor for Efficacy

Introduction: The global increase in obesity incidence results in an increase of type 2 diabetes mellitus (T2DM). Surgical treatment has proven to be effective, however it carries a high risk of complications. The duodenal-jejunal bypass liner (EndoBarrier®, GI Dynamics, EB) is an endoscopic implant that mimics the intestinal bypass portion of the Roux-en-Y Gastric Bypass. It results in weight loss and improvements in glucose control in obese patients with T2 diabetes mellitus (T2DM). Aims and Methods: This is a analysis of a prospective, controlled, multicentre study aimed to identify factors associated with an outcome of EB for T2DM. Results: Seventy subjects (45 with an implant, 25 controls) were included in the study. The groups were comparable with respect to age, gender, BMI (mean 41.7 vs. 39.5 kg/m2), T2DM duration (7.8 vs. 8.3 years), HbA1c level (88 vs. 86 mmol/mol) and T2DM treatment. In the EB group, all devices were successfully implanted. Only 6 devices had to be explanted prior to the end of the 10 months study period (bleeding, dislocation and need for ERCP because of choledocholithiasis). At 10 months there was significantly greater weight loss and %EWL (19% vs. 7% and 43 vs. 12) and significantly improved long term compensation of T2DM marker HbA1c (decreased by 25 vs. 10 mmol/mol) in the EB group. T2DM medicinal treatment could be reduced in more device subjects than controls. There was no serious adverse event. Deepness of anchor ingrow, lower initial BMI and lower body height were identified as positive factors for efficacy of EB for T2DM compensation. Conclusion: The EB is safe when implanted for 10 months, and results in significant weight loss and HbA1c reduction. Deepness of anchor ingrow, lower initial BMI and lower body height could be positive factors for efficacy. Disclosure M. Benes: None. P. Drastich: None. T. Hucl: None.

Su1978 - Duodeno-Jejunal Bypass Liner for the Treatment of Diabetes Mellitus in Obese Patients: Completeness of Duodenal Blinding as the Key Factor for Efficacy

Su1978 - Duodeno-Jejunal Bypass Liner for the Treatment of Diabetes Mellitus in Obese Patients: Completeness of Duodenal Blinding as the Key Factor for Efficacy

Emerging and current trend in the investigation of obesity in clinical practice

Obesity is a medical condition in which excess body fat has accumulated to the extent that it could produce a negative adverse health effect. The various emerging and current investigational methods or techniques for the analysis and determination of total body fat composition and body fat percentage are the theoretical gold standard method of underwater weighing which has its foundation on Archimedes' principle, Bioelectrical Impedance Analysis (BIA), Whole-body Air Displacement Plethysmography (ADP), Dual-Energy X-ray Absorptiometry (DEXA), Near Infrared interactance (NIR), Body Average Density (BAD) Measurement, Ultrasound Sonography Technique (UST) and Anthropometric Measurements (AM) such as triceps skinfold thickness (TSF), Mid-upper arm circumference (MAC), Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Stature ratio (WSR or WHtR), Waist-to-thigh ratio (WTR) and/or Obesity Determinant Indices (ODI). We the authors of this research work currently propose and recommend the Obesity Determinant Indices (ODI) as novel anthropometric measurements that will serve as a more reliable predictor and accurate indicator of cardiovascular disease risk factors, including body fat redistribution, hypertension, dyslipidemia, stroke, ischemic heart diseases, heart failure, chronic kidney disease, sleep apnea and type 2 diabetes mellitus in obese patients. Furthermore, We also jointly propose and recommend the diagnostic and interventional criteria for obesity treatment which are the First Criteria (Criteria-I) and Second Criteria (Criteria-II). These criteria take into consideration the presence of an individual body mass index (BMI), presence of at least one waist circumference (WC) dependent parameters (such as WC or WHR or WHtR or WTR or any of the ODI) that fall into the obesity reference range, and/or presence of at least one obesity-related comorbid conditions/risk factors such as hypertension, type 2 diabetes mellitus, dyslipidemia, osteoarthritis, rheumatoid arthritis, polycystic ovarian syndrome, heart failure, ischemic heart diseases, sleep apnea, depression disorders, anorexia nervosa, bulimia nervosa or any other obesity-associated neuropsychiatric disorders. In conclusion, initiation of appropriate treatment in the form of High-Intensity Lifestyle Interventions alone or a combination of pharmacotherapy with Low-to-Moderate-Intensity Lifestyle Interventions should be commenced for any patient that meet these stipulated criteria guidelines.

Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study.

OBJECTIVE:Obesity is known to be a risk factor for many diseases including dermatological problems. Here, we aimed to determine the cutaneous manifestations in obese patients and the frequency of the accompanying dermatoses and to investigate the effect of diabetes mellitus in obese patients on cutaneous manifestations compared with the control group.METHODS:Our study included a total of 600 adults: 450 obese volunteers and 150 healthy volunteers. The number of diabetic obese patients was 138 (30%), whereas that of nondiabetic obese patients was 312 (70%). A detailed dermatological examination was performed for each case, and accompanying dermatoses were compared.RESULTS:The mean body mass index (BMI) in the obese patients and control group was 37.22 kg/m2 and 22.23 kg/m2, respectively. The most common dermatoses in the obese patients were, according to their frequency: striae distensae (291 patients, 64.7%), acrochordon (236 patients, 52.4%), acanthosis nigricans (213 patients, 47.3%), plantar hyperkeratosis (209 patients, 46.4%), and venous insufficiency (202 patients, 44.9%). Although hirsutism was more frequently observed in the nondiabetic obese group than in the diabetic obese group, stasis dermatitis was less frequently observed (p<0.05).CONCLUSION:We found that many dermatoses are more frequently observed in the obese patients than in the controls. We observed that the effect of obesity on skin is different from that of diabetes mellitus and that cutaneous manifestations of obesity occur more frequently. More extensive, comprehensive, and advanced studies on this subject are required.

The Role of Sleeve Gastrectomy on Preventing Type 2 Diabetes Mellitus.

AIM:To investigate the effect of bariatric surgery on HbA1c and serum cortisol levels in morbidly obese patients without type 2 diabetes mellitus.MATERIALS AND METHODS:Twenty-nine patients who underwent sleeve gastrectomy and whose body mass index was> 40 were included in the present study. Patients’ files were reviewed retrospectively. Those with diabetes mellitus and those with age <18 were excluded from the study. Pre-operative and 1-year post operative data were documented. The obtained data were analysed by SPSS statistical program.RESULTS:The mean age of the patients was 27.4 ± 8.4. 5 of the patients were male, and 24 were female. The mean body mass index of the patients was 44 ± 2.3. 1 patient [3.4%] had hypertension. Four patients [13.7%] had gastroesophageal reflux disease. The number of smokers was 7 [24.1%], and the number of alcohol users was 3 [10.3%]. There was a statistically significant decrease in HbA1c, body mass index values after operation [p value <0.01], but cortisol was not different [p value = 0.72].CONCLUSION:In this present study we found that bariatric surgery caused a significant decrease in HbA1c levels in non-diabetic patients, suggesting that bariatric surgery may prevent Type 2 Diabetes Mellitus in obese patients.

Effects of saxagliptin on glucose homeostasis and body composition of obese patients with newly diagnosed pre-diabetes.

To assess the effect of saxagliptin monotherapy on blood glucose and islet β-cell function in obese patients with newly diagnosed pre-diabetes and abnormal fat metabolism. A 24-week, randomized controlled trial was conducted involving 25 obese subjects with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) (mean age 45years) to receive lifestyle intervention only (control group) or combined with saxagliptin 2.5mg or 5mg daily (S2.5 or S5 group), metformin 1500mg daily (Met group). Anthropometrics, body fat and biochemical parameters were measured before and after 4, 12 and 24weeks intervention. S5 group and Met group showed a significant decrease in fasting plasma glucose (FPG) and HbA1c compared with the control group (all P<0.05) after 24-week intervention. However, the decrease in 2h postprandial plasma glucose levels (2hPPG) in S5 group were greater compared with control group (P<0.01). Insulin resistance (HOMA-IR) was reduced in S5 group, Met group and control group (P<0.05), and the β-cell function (HOMA-β) was improved in all groups (P<0.05). However, the changes in obesity-related indicators including waist circumference, hip circumference, weight, BMI, body fat, percentage of body fat and waist-to-hip fat ratio were greate in Met group (all P<0.05) compared with other groups (P>0.05). Saxagliptin monotherapy may prevent or delay the progression of IGT or IFG to type 2 diabetes mellitus in obese patients with newly diagnosed pre-diabetes. ClinicalTrials.gov: NCT01960205.

Effect of laparoscopic sleeve gatrectomy on type 2 diabetes mellitus in obese patients with body mass index less than 40 kg/m2

To evaluate the effect of laparoscopic sleeve gastrectomy(LSG) on type 2 diabetes mellitus (T2DM) in patient with a body mass index(BMI) less than 40 kg/m2. Twenty four obese patients with T2DM and BMI less than 40 kg/m2 received LSG between 1 January 2011 and 1 September 2013 at the Department of General Surgery in Chinese PLA General Hospital. The clinical data and 3-year follow-up outcomes regarding weight loss and remission of diabetes were retrospectively analyzed. There were 10 males and 14 females with a median age of 40.8(35 to 48) years. The preoperative body weight and BMI was(99.9±15.0) kg and (34.4±2.8) kg/m2, respectively. The median duration of type 2 diabetes was 4.3(2 to 15) years. The preoperative fasting blood glucose and glycosylated hemoglobin(HbAlc) was (11.4±1.3) mmol/L and (8.7±0.8)%, respectively. All these patients were preoperatively diagnosed as T2DM by the multidisciplinary experts of the surgical treatment team for obesity and diabetes in our center. All these patients were eligible for surgical treatment through the screening and evaluation by the multidisciplinary joint outpatient service. All the procedures were successfully completed without conversion to laparotomy. There were no severe postoperative complications. The mean fasting blood glucose was (6.4±1.8) mmol/L, (6.1±1.7) mmol/L, (6.0±1.5) mmol/L, (5.9±1.4) mmol/L and (6.0±1.4) mmol/L, respectively, at 6, 9, 12, 24 and 36 months after operation. The mean HbA1c in the same observation intervals was (6.6±1.1)%, (6.2±1.2)%, (6.1±1.2)%, (6.0±1.3)% and (6.1±1.3)%, respectively. The body weight was (89.4±11.4) kg, (86.3±10.6) kg, (83.1±10.2) kg,(80.6±9.8) kg and (81.3±10.1) kg, respectively. The corresponding BMI was (30.8±1.6) kg/m2, (29.8±1.5) kg/m2, (28.7±1.5) kg/m2, (27.8±1.8) kg/m2 and (28.1±1.8) kg/m2, respectively. The %EWL was (36.7±8.7)%, (47.6±12.5)%, (58.8±16.4)%, (67.2±20.3)% and (64.8±21.5)%, respectively. The overall remission rate of diabetes at 6, 9, 12, 24 and 36 months was 50.0%(12/24), 79.2%(19/24), 70.8%(17/24), 66.7%(16/24) and 62.5%(15/24), respectively. The complete remission rate was 33.3%(8/24), 50.0%(12/24), 54.2%(13/24), 45.8%(11/24) and 50.0%(12/24), respectively. For patients with a duration of T2DM shorter than 5 years, the overall remission rate at 9, 12 and 24 months after operation was 10/10, 9/10 and 9/10, respectively, significantly higher than that of patients with a duration of 11-15 years (2/6, 2/6 and 2/6, Fisher's exact tests, P=0.008, 0.036 and 0.036, respectively). The present study confirms the efficacy of LSG in the treatment of T2DM patients with a BMI less than 40 kg/m2.

The duodenal-jejunal bypass liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus in obese patients – efficacy and factors predicting optimal effects

The duodenal-jejunal bypass liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus in obese patients – efficacy and factors predicting optimal effects

566 Final Results of Multi-Center, Prospective, Controlled Trial of the Duodeno-Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus in Obese Patients: Efficacy and Factors Predicting a Suboptimal Effect

566 Final Results of Multi-Center, Prospective, Controlled Trial of the Duodeno-Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus in Obese Patients: Efficacy and Factors Predicting a Suboptimal Effect

Surgery in the treatment of type 2 diabetes mellitus.

The prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. The relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. The aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results. Medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus. Remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. Complete remission rate after surgery with the new criteria is lower than was considered before. Randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. The recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥ 5 years of follow-up. Despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. Incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear. Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. The most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. More research is needed to explore the mechanisms of glycemic control after bariatric surgery.

EXTERNAL VALIDATION OF THE DIAREM SCORE AS REMISSION PREDICTOR OF DIABETES MELLITUS TYPE 2 IN OBESE PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS

Background : DiaRem score consists in preoperative model for predicting remission of type 2 diabetes mellitus in obese patients who underwent gastric bypass. Aim : To evaluate the applicability of DiaRem comparing the scores obtained preoperatively with remission of T2DM after surgery. Method : Preoperative parameters such as age, use of insulin, oral hypoglycemic agents and glycated hemoglobin, were retrospectively evaluated in diabetic patients undergoing gastric bypass during the period between July 2012 to July 2013. Through these data the DiaRem score were applied. The results of fasting blood glucose and glycated hemoglobin were requested prospectively. Results : Were selected 70 patients; the remission of T2DM after surgery was found in 42 (60%) and no remission in 28 (40%). Checking the final score, it was observed that: from 0 to 2 points, 94.1% of patients remitted completely; between 3 and 7 had remission in 68.9%, of which 42.8% complete; from 8 to 12, 57.1% achieved complete remission; between 13 to 17, 87.5% did not achieve remission and was not seen this complete remission group; between 18 to 22, 88.9% were not remitted. Conclusion : The DiaRem score showed appropriate tool to assess remission of T2DM in obese patients who will undergo gastric bypass.